ATLANTA—Last year, the CDC recommended that children with cochlear implants receive the 7-valent pneumococcal vaccine, the 23-valent vaccine, or both; the vaccinations should follow the Advisory Committee on Immunization Practices (ACIP) schedule for individuals at high risk. These recommendations were based on reports that children with cochlear implants were at increased risk for pneumococcal meningitis.[1]

Recent findings by the CDC, the FDA, and state health departments support this recommendation: Children 6 years and older with cochlear implants have a risk for pneumococcal meningitis that is substantially higher than that seen in the general population.

Therefore, the ACIP has recommended the following for individuals who have received or are scheduled to receive a cochlear implant (see Table 1):
• Children younger than 24 months should receive the 7-valent vaccine. Children with a lapse in vaccination should be immunized according to the catch-up schedule that was issued after the shortage of the 7-valent vaccine was resolved.
• Children between the ages of 2 and 5 years who have not received the 7-valent vaccine should be vaccinated according to the schedule for high-risk individuals. Children with a lapse in vaccination should receive the 7-valent vaccine according to the catch-up schedule. Children who have completed the 7-valent vaccination series should receive the 23-valent vaccine two or more months after receiving the 7-valent vaccine.
• Persons ages 5 to 64 years should receive the 23-valent vaccine according to the schedule for persons with chronic illness—ie, a single dose.
• Individuals who are scheduled to receive a cochlear implant should be up to date on age-appropriate pneumococcal vaccination at least two weeks before surgery, if possible.

Health care providers should review the vaccination records of all prospective cochlear implant recipients to ensure that they have received the pneumococcal vaccine according to the age-appropriate schedule for persons at high risk. In addition, because there is limited information about Streptococcus pneumoniae serotypes causing pneumococcal meningitis in those with cochlear implants, providers are encouraged to send isolates to their state health departments, who can then forward them to the CDC. To send an isolate, contact the CDC’s National Center for Infectious Diseases by telephone at (404) 639-2215.

Cases of meningitis in patients with cochlear implants can be reported to the FDA’s MedWatch using its Web site at www.accessdata.fda.gov/scripts/medwatch; by telephone at (800) 332-1088; or by fax at (800) 332-0178. The mailing address is MedWatch, Food and Drug Administration, HF-2, 5600 Fishers Lane, Rockville, MD 20857.

Table 1 Recommended Pneumococcal Vaccination Schedule for Children With Cochlear Implants
Age at first 7-valent dose (months)*	7-valent primary series	7-valent additional dose	23-valent dose
2 – 6	3 doses, 2 months apart†	1 dose at 12 – 15 months‡	Indicated at 24 months or older§
7 – 11	2 doses, 2 months apart†	1 dose at 12 – 15 months‡	Indicated at 24 months or older§
12 – 23	2 doses, 2 months apart||	Not indicated	Indicated at 24 months or older§
24 – 59	2 doses, 2 months apart||	Not indicated	Indicated§
60 or older	Not indicated¶	Not indicated¶	Indicated
* A schedule with a reduced number of total 7-valent doses is indicated if children start late or are incompletely vaccinated. Children with a lapse in vaccination should be vaccinated according to the catch-up schedule. † For children vaccinated at younger than 1 year, the minimum interval between doses is four weeks. ‡ The additional dose should be administered at least eight weeks after the primary series has been completed. § Children younger than 5 years should complete the 7-valent series first. The 23-valent vaccine should be administered to children 24 months and older at least eight weeks after the last dose of the 7-valent vaccine. || Minimum interval between doses is eight weeks. ¶ The 7-valent vaccine is not generally recommended for persons 5 years and older. Adapted from MMWR Morb Mortal Wkly Rep. 2003;52:739-740.

—Gale Jurasek